title: Alternative procedures for the treatment of cervical spondylotic myelopathy: arthroplasty, oblique corpectomy, skip laminectomy: evaluation of comparative effectiveness and safety.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  To perform an evidence synthesis of the literature assessing the efficacy of arthroplasty, oblique corpectomy without fusion, and skip laminectomy to treat symptomatic cervical spondylotic myelopathy (CSM).
  
  
  BACKGROUND
  Traditionally, patients with symptomatic cervical spinal cord compression due to degenerative disease have been treated with anterior or posterior approaches or both. Recent reports suggest that there are several nontraditional management strategies that merit attention. The anterior procedures include decompression and anterior reconstruction with an artificial disc and oblique corpectomy without fusion. A posterior option is decompression, using the skip laminectomy technique.
  
  
  METHODS
  We conducted a systematic search in MEDLINE and the Cochrane Collaboration Library for literature published through October 15, 2012, on human studies published in the English language containing abstracts to answer the following key questions: (1) Is there evidence that artificial disc replacement after neural decompression results in equal or improved outcomes compared with anterior cervical decompression and fusion for CSM? (2) Describe the outcomes of oblique corpectomy without fusion for CSM? (3) Is there evidence that skip laminectomy results in equal or improved outcomes compared with laminoplasty for CSM?
  
  
  RESULTS
  The initial literature search yielded 141 unique, potentially relevant citations, which were evaluated against the inclusion/exclusion criteria set a priori. A total of 10 studies were selected for inclusion. For question 1, 2 studies suggested that neurological outcomes favored artificial disc replacement compared with anterior cervical decompression and fusion, whereas functional and pain outcomes were inconsistently reported. For question 2, 5 reported case series suggested favorable neurological, functional, and pain outcomes associated with oblique corpectomy in subjects with CSM, compared with the pretreatment condition. For question 3, 3 studies comparing laminoplasty with skip laminectomy suggested similar neurological outcomes between treatment groups, although functional and pain outcomes were inconsistently reported.
  
  
  CONCLUSIONS
  A paucity of high-quality literature exists regarding treatment outcomes associated with arthroplasty, oblique corpectomy without fusion, and skip laminectomy for symptomatic CSM. Comparative prospective studies with long-term follow-up and standardized outcome measures are needed to assess treatment outcomes associated with these alternative techniques appropriately. EVIDENCE-BASED CLINICAL RECOMMENDATIONS:
  
  
  CONCLUSIONS
  No recommendation can be made from comparative literature regarding treatment outcomes comparing ADR with ACDF for CSM.
  
  
  METHODS
  Insufficient.
  
  
  METHODS
  Strong.
  
  
  CONCLUSIONS
  No recommendation can be made from comparative literature regarding treatment outcomes comparing laminoplasty with skip laminectomy for CSM.
  
  
  METHODS
  Low.
  
  
  METHODS
  Strong. SUMMARY STATEMENTS: Oblique corpectomy is an option in selected cases of CSM. It should not be considered a first-line treatment strategy because of the relatively high morbidity associated with this procedure.
authors.affiliation: *Rush University Medical Center, Chicago, IL †University of Kansas, Kansas City, KS ‡Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada §Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA; and ¶Spectrum Research, Inc., Tacoma, WA.
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Traynelis
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arnold
authors.forename: Daryl R
authors.initials: DR
authors.lastname: Fourney
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bransford
authors.forename: Dena J
authors.initials: DJ
authors.lastname: Fischer
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Skelly
mesh_terms: D001178:Arthroplasty / Q000379:methods; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D017586:Diskectomy / Q000379:methods; D006801:Humans; D007796:Laminectomy / Q000379:methods; D013118:Spinal Cord Diseases / Q000601:surgery*; D055009:Spondylosis / Q000601:surgery*; D016896:Treatment Outcome